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Are viruses the cause of mental illness, or does stress or mental disorder produce impaired immunity, with increased susceptibility to infection? These two separate but not unrelated questions have been debated periodically and there has been much renewed interest recently, with increased sophistication in immunology and widespread topical concern about immunodeficiency. The neuropsychiatry of the acquired immunodeficiency syndrome (AIDS) (Snider et al, 1983; Carne & Adler, 1986; Wortis, 1986; Burton, 1987; Fenton, 1987) and the validity of a ‘post-viral fatigue syndrome’ as a clinical entity (Behan, 1983; Southern & Oldstone, 1986; Dawson, 1987; David et al, 1988) are not discussed here, but have been dealt with in the editorials and reviews cited.

A small yet significant minority of contemporary patients with endogenous depressive illness who are treated with electroconvulsive therapy (ECT) gain little or no benefit. It is argued that the use of clinical features alone may not improve the ability to predict outcome after ECT. Many biological measures have been used to attempt to identify depressed patients for whom ECT would be an effective treatment, but none has yet been shown to be superior to clinical predictors. Depressed patients show a wide range of physiological responses to the first treatment of a course of ECT. Of these physiological responses, estimations of seizure threshold and of the release of posterior pituitary peptides merit further investigation as putative predictors of recovery.

Research which tries to understand human experience within the time dimension is entering difficult and uncomfortable territory. Long before the first prospecting research worker arrived on this scene with his questionnaires and statistical methods, creative writers had been exploring the same terrain. Take poetry, for instance. When poets write about the passage of time the visions which they conjure seem nearly always to carry menace. An image offered by Yeats exactly captures the sense of helplessness and haplessness which we may all sometimes experience under the pressure of passing time:

The literature on parricide is reviewed with special reference to women. Seventeen female parricides (14 matricides, 3 patricides) were identified: in a remand prison (11), a Special Hospital (5), and a Regional Secure Unit (1). Six were schizophrenic, five had psychotic depression, three had personality disorders, and one was alcoholic. Two of the patricides had no psychiatric disorder but retaliated against violent fathers. Regardless of psychiatric diagnosis, matricides were mostly single, socially isolated women in mid-life, living alone with a domineering mother in a mutually dependent but hostile relationship. Similar characteristics are found in male matricides, who are predominantly schizophrenic. It is suggested that these features are of greater significance in matricide than the specific form of psychiatric disorder. Compared with filicides, matricides were significantly older, were single, and more often suffered from mental illness and substance abuse. Attention is drawn to the possible homicidal risk associated with delusions of poisoning and hypochondriacal delusions.

The psychopathology of a series of patients referred to a combined psychiatric-toxicological assessment service with the specific complaint of being, or having been, poisoned is described, and related to the nature of their exposure to incriminated agents. The need for and value of this service are discussed.

DSM-III diagnoses and responses to the Beck Depression Inventory (BDI) were examined in 71 consecutive admissions to an inpatient psychiatric crisis service following deliberate self-harm. Although 80% of the admitted patients were moderately or severely depressed according to BDI scores, only 31 % were diagnosed with a major depressive episode. While all of the self-harm patients may be viewed as experiencing severe subjective distress, only a minority were shown to suffer from DSM-III depressive illness. The high depression scores on the BDI may be related to the patients' extreme distress preceding a crisis admission and to the high prevalence of personality disorders in this group of patients.

During open trials of intravenous and oral S-adenosyl methionine (SAM) and a placebo-controlled trial of intravenous SAM in 29 patients, 25 patients had SAM and four had placebo (27 courses of SAM, two of the patients receiving two trials apiece). Nine of 11 bipolar patients (all SAM-treated) switched into elevated mood state (hypomania, mania and euphoria) and two did not respond. Six endogenous unipolar patients improved and five did not. No non-endogenous patient or placebo patient responded for more than 14 days. No unipolar patient switched into elated mood. In eleven (38%) trials and nine (33%) patients there was a switch from depression to elation. Biochemical data from the cerebrospinal fluid of eight patients suggested that the role of the dopaminergic system should be further explored.

Poverty of speech, a prominent feature of the negative symptom construct in schizophrenia, was assessed longitudinally in 12 schizophrenic and 13 depressed subjects at hospital admission and about seven months after discharge in order to evaluate hypotheses concerning course and diagnostic specificity. Multiple measures of the poverty of speech construct were employed, including both clinical and quantitative indices. During the inpatient period, poverty of speech was more pronounced among depressed than schizophrenic subjects. Examination of this specific negative symptom across inpatient and followup evaluations indicated that poverty of speech increased among schizophrenic subjects, but remained relatively stable or declined among depressed subjects. These results suggest that the processes underlying poverty of speech may differ in schizophrenia and depression.

Schizophrenic patients living in high contact with relatives having high expressed emotion (EE) were recruited for a trial of social interventions. The patients were maintained on neuroleptic medication, while their families were randomly assigned to education plus family therapy or education plus a relatives group. Eleven out of 12 families accepted family therapy in the home, whereas only six out of 11 families were compliant with the relatives group. Non-compliance was associated with a poorer outcome for the patients in terms of the relapse rate. The relapse rate over nine months in the family therapy stream was 8%, while that in compliant families in the relatives group stream was 17%. Patients' social functioning showed small, non-significant, gains. The data from the current trial were compared with data from a previous trial. The lowering of the relapse rate in schizophrenia appears to be mediated by reductions in relatives' EE and/or face-to-face contact, and is not explained by better compliance with medication. Reduction in EE and/or contact was associated with a minuscule relapse rate (5%). Very little change occurred in families who were non-compliant with the relatives group. On the basis of these findings, we recommend that the most cost-effective procedure is to establish relatives groups in conjunction with family education and one or more initial family therapy sessions in the home. It is particularly important to offer home visits to families who are unable to or refuse to attend the relatives groups.

General-practice-based psychiatric clinics have increased substantially in recent years. We investigated the influence on psychiatric admissions of this style of practice in England over an 18-year period. We utilised data from a previous survey concerned with this type of work (Strathdee & Williams, 1984) and compared them with figures on psychiatric admissions. Parts of the country in which there has been greater development of general-practice-based psychiatric clinics were also those in which there has been a steeper decrease in psychiatric admissions. Further analysis showed this to be due primarily to an effect on admission of non-psychotic patients.

The literature on referral of patients by GPs to psychiatrists and mental health specialists is examined. Referrals to psychiatrists account for 3% of all those made by GPs, but the individual rates vary widely. The proportion of patients referred to psychiatrists and paramedical mental health workers in general practice is unknown, but probably substantial.

The quality of life of chronically mentally ill patients in acute wards in a district general hospital, a hostel ward and group homes was compared. Within the spectrum of care of these patients, the severity of psychopathology corresponded to their placement. Analysis, including adjustments for the influence of psychopathology, showed differences between the three types of facility. Although differences existed between all types of care, residents in group homes and the hostel ward shared more similarities in quality of life than those in the district general hospital. Problems of caring for the chronically mentally ill on acute wards are highlighted.

Fifty patients suffering from the alcohol dependence syndrome were detoxified over a 10-day period using a reducing regime of chlordiazepoxide. Twenty-four had been consuming minor tranquillisers together with alcohol prior to admission. The severity of the withdrawal syndrome was assessed daily but no differences were found between the 26 who had taken alcohol alone and the 24 who had taken a combination of alcohol and drugs. Four from each group had a transient hallucinosis and none had fits.

Abnormal neuroendocrine responses have been found in depression and eating disorders. It remains unclear whether these reflect an underlying shared biology or epiphenomena. To evaluate this further, we conducted the 1 mg DST and the TSH response to 500 μg i.v. TRH in normal-weight bulimics and controls. Bulimics (n = 18) demonstrated significantly more DST non-suppression (45%) than controls (18%; n = 20). In the bulimic group, non-suppressors were significantly thinner than suppressors, but did not differ from them on any measure of depression. Bulimics (n = 19) and controls (n = 12) responded similarly without blunting on the TSH response to TRH. These data suggest that DST non-suppression may be related to non-specific variables such as weight. Bulimics do not demonstrate TSH blunting as found in some depressed patients. These tests do not support evidence for a biological link between these disorders.

Sigmund Freud's family background holds extraordinary fascination, not just because he is an historic figure but because his very ideas centred around the influence of formative family relationships. In addition, Freud used his own experiences as one means of research, from which he concluded that some personal details only may be available in disguised form. This has proved an irresistible challenge to those interested in the evolution of Freud's theories.

Two cases are presented in which psychotic patients with neuroleptic malignant syndrome were treated with bromocriptine and thioridazine simultaneously, with a resulting control of both problems. The authors feel that this method needs further study, in the light of the potentially large number of patients at risk for these illnesses. The use of creatinine phosphokinase level as an indicator of value in NMS is also discussed.

Pathophysiological theories of tardive dyskinesia (TD) suggest the possibility of structural changes in the central nervous system of patients with TD. This report describes a case of choreoathetoid dyskinesia and spastic dysphonia associated with clinical and electromyographic signs of muscle denervation. The findings of this case suggest that the neurological syndrome originates within basal ganglia nuclei but may also extend to the peripheral neuromuscular system.

Data were obtained for some 89 psychiatrists who were responsible for 372 first-author research publications over the period 1978–1984, to define predictors of productivity (rate of publishing in scientific journals). A principal components analysis suggested three key researcher dimensions, comprising ‘track record’, ‘experience’ and ‘resource base’ variables. The ‘track record’ dimension was the only significant predictor and was contributed to principally by the number of publications in the early part of the review period, number of citations to published work, rating by peers, and possessions of a research degree.

A case showing various involuntary movements during mianserin treatment and after a withdrawal of mianserin is described. This is the first case report of mianserin-induced involuntary movements. The report suggests that these symptoms can occur with a therapeutic dose of mianserin in certain susceptible patients.